Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients


Dynamic magnetic resonance imaging (MRI) allows real-time characterization of upper airway collapse in sleeping subjects with obstructive sleep apnea (OSA). The aim of our study was to use sleep MRI to compare differences in upper airway collapse sites between BMI-matched subjects with mild OSA and severe OSA. This is a prospective, nested case–control study using dynamic sleep MRI to compare 15 severe OSA subjects (AHI >40) and 15 mild OSA (AHI <10) subjects, who were matched for BMI. Upper airway imaging was performed on sleeping subjects in a 3.0 T MRI scanner. Sleep MRI movies were used by blinded reviewers to identify retropalatal (RP), retroglossal (RG), and lateral pharyngeal wall (LPW) airway collapse. Mean AHI in the severe OSA group was 70.3 ± 23 events/h, and in the mild group was 7.8 ± 1 events/h (p < 0.001). All mild and severe OSA subjects demonstrated retropalatal airway collapse. Eighty percent in the mild group showed single-level RP collapse (p < 0.001). All subjects in the severe group showed multi-level collapse: RP + LPW (n = 9), RP + RG + LPW (n = 6). All severe OSA subjects showed LPW collapse, as compared with three subjects in the mild group (p < 0.001). LPW collapse was positively associated with AHI in simple regression analysis (β = 51.8, p < 0.001). In conclusion, severe OSA patients present with more lateral pharyngeal wall collapse as compared to BMI-matched mild OSA patients.

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  1. 1.

    Abramson Z, Susarla S, August M, Troulis M, Kaban L (2010) Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. J Oral Maxillofac Surg 68(2):354–362. doi:10.1016/j.joms.2009.09.087

  2. 2.

    Battagel JM, Johal A, Kotecha B (2000) A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod 22(4):353–365

  3. 3.

    Susarla SM, Abramson ZR, Dodson TB, Kaban LB (2010) Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea. J Oral Maxillofac Surg 68(11):2846–2855. doi:10.1016/j.joms.2010.06.196

  4. 4.

    Terris DJ, Hanasono MM, Liu YC (2000) Reliability of the Muller maneuver and its association with sleep-disordered breathing. Laryngoscope 110(11):1819–1823. doi:10.1097/00005537-200011000-00010

  5. 5.

    Guilleminault C, Riley R, Powell N (1984) Obstructive sleep apnea and cephalometric roentgenograms. Am Rev Respir Dis 130(1):145–146

  6. 6.

    Barrera JE (2011) Sleep magnetic resonance imaging: dynamic characteristics of the airway during sleep in obstructive sleep apnea syndrome. Laryngoscope 121(6):1327–1335. doi:10.1002/lary.21810

  7. 7.

    Kavcic P, Koren A, Koritnik B, Fajdiga I, Dolenc Groselj L (2014) Sleep magnetic resonance imaging with electroencephalogram in obstructive sleep apnea syndrome. Laryngoscope. doi:10.1002/lary.25085

  8. 8.

    Ikeda K, Ogura M, Oshima T, Suzuki H, Higano S, Takahashi S, Kurosawa H, Hida W, Matsuoka H, Takasaka T (2001) Quantitative assessment of the pharyngeal airway by dynamic magnetic resonance imaging in obstructive sleep apnea syndrome. Ann Otol Rhinol Laryngol 110(2):183–189

  9. 9.

    Moriwaki H, Inoue Y, Namba K, Suto Y, Chiba S, Moriyama H (2009) Clinical significance of upper airway obstruction pattern during apneic episodes on ultrafast dynamic magnetic resonance imaging. Auris Nasus Larynx 36(2):187–191. doi:10.1016/j.anl.2008.04.004

  10. 10.

    Chang YC, Huon LK, Pham VT, Chen YJ, Jiang SF, Shih TT, Tran TT, Wang YH, Lin C, Tsao J, Lo MT, Wang PC (2014) Synchronized imaging and acoustic analysis of the upper airway in patients with sleep-disordered breathing. Physiol Meas 35(12):2501–2512. doi:10.1088/0967-3334/35/12/2501

  11. 11.

    Chen YJ, Shih TT, Chang YC, Hsu YC, Huon LK, Lo MT, Pham VT, Lin C, Wang PC (2015) Acoustic-integrated dynamic MR imaging for a patient with obstructive sleep apnea. Magn Reson Imaging. doi:10.1016/j.mri.2015.08.004

  12. 12.

    Shepard JW Jr, Gefter WB, Guilleminault C, Hoffman EA, Hoffstein V, Hudgel DW, Suratt PM, White DP (1991) Evaluation of the upper airway in patients with obstructive sleep apnea. Sleep 14(4):361–371

  13. 13.

    Borowiecki B, Pollak CP, Weitzman ED, Rakoff S, Imperato J (1978) Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnea syndrome. Laryngoscope 88(8 Pt 1):1310–1313. doi:10.1288/00005537-197808000-00012

  14. 14.

    Guilleminault C, Hill MH, Simmons FB, Powell N, Riley R, Stoohs R (1997) Passive constriction of the upper airway during central apneas: fiberoptic and EMG investigations. Respir Physiol 108(1):11–22

  15. 15.

    Chuang LP, Chen NH, Li HY, Lin SW, Chou YT, Wang CJ, Liao YF, Tsai YH (2009) Dynamic upper airway changes during sleep in patients with obstructive sleep apnea syndrome. Acta Otolaryngol 129(12):1474–1479. doi:10.3109/00016480902780242

  16. 16.

    Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J (2000) Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 161(2 Pt 1):347–352. doi:10.1164/ajrccm.161.2.9810091

  17. 17.

    Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas A, Lin HM, Kales A, Chrousos GP (2000) Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 85(3):1151–1158. doi:10.1210/jcem.85.3.6484

  18. 18.

    Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM, Sleep Heart Health Study Research Group (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 162(8):893–900

  19. 19.

    Shelton KE, Woodson H, Gay S, Suratt PM (1993) Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis 148(2):462–466. doi:10.1164/ajrccm/148.2.462

  20. 20.

    Pahkala R, Seppa J, Ikonen A, Smirnov G, Tuomilehto H (2014) The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea. Sleep Breath 18(2):275–282. doi:10.1007/s11325-013-0878-4

  21. 21.

    Horner RL, Mohiaddin RH, Lowell DG, Shea SA, Burman ED, Longmore DB, Guz A (1989) Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J 2(7):613–622

  22. 22.

    Hoffstein V, Mateika S (1992) Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea. Eur Respir J 5(4):377–381

  23. 23.

    Johns FR, Strollo PJ Jr, Buckley M, Constantino J (1998) The influence of craniofacial structure on obstructive sleep apnea in young adults. J Oral Maxillofac Surg 56(5):596–602 (discussion 602–603)

  24. 24.

    Akan H, Aksoz T, Belet U, Sesen T (2004) Dynamic upper airway soft-tissue and caliber changes in healthy subjects and snoring patients. AJNR Am J Neuroradiol 25(10):1846–1850

  25. 25.

    Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI (1995) Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 152(5 Pt 1):1673–1689. doi:10.1164/ajrccm.152.5.7582313

  26. 26.

    Lan MC, Liu SY, Lan MY, Modi R, Capasso R (2015) Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea. Laryngoscope. doi:10.1002/lary.25126

  27. 27.

    Soares D, Sinawe H, Folbe AJ, Yoo G, Badr S, Rowley JA, Lin HS (2012) Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope 122(2):473–479. doi:10.1002/lary.22474

  28. 28.

    Liu SY, Huon LK, Powell NB, Riley R, Cho HG, Torre C, Capasso R (2015) Lateral pharyngeal wall tension after maxillomandibular advancement for obstructive sleep apnea is a marker for surgical success: observations from drug-induced sleep endoscopy. J Oral Maxillofac Surg. doi:10.1016/j.joms.2015.01.028

  29. 29.

    Li KK, Guilleminault C, Riley RW, Powell NB (2002) Obstructive sleep apnea and maxillomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. J Oral Maxillofac Surg 60(5):526–530 (discussion 531)

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This study was sponsored by the National Taiwan University Hospital, Cathay General Hospital Joint Research Fund (No. 102-CGN08) and the National Central University, Cathay General Hospital Joint Research Fund (Nos. 101CGH-NCUA4, 103CGH-NCU-A1 and 104CGH-NCU-A1).

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Correspondence to Pa-Chun Wang.

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Huon, L., Liu, S.Y., Shih, T.T. et al. Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients. Eur Arch Otorhinolaryngol 273, 4021–4026 (2016) doi:10.1007/s00405-016-4131-1

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  • Sleep magnetic resonance imaging
  • Lateral pharyngeal wall collapse
  • Obstructive sleep apnea